What Happens During Lumbar Disc Herniation Surgery (Step by Step)
Understanding Lumbar Herniated Disc Surgery: What Really Happens and When It’s Needed
What Happens During Lumbar Herniated Disc Surgery?
Let me show you exactly what’s happening in your spine when you have a herniated disc—and how we fix it surgically.
Before I walk you through what happens during a lumbar herniated disc surgery, let’s first understand why you might need one. I’m going to explain this the same way I do with my patients in consultation.
Your spine consists of bones called vertebrae. These bones are in the shape of rings, and they all stack up together and form a column. This column has a crucial job—protecting the spinal cord and the nerves that travel through it. In your lumbar spine, which is in your low back, the nerves that exit your spinal cord run through this column. Then, they travel through small tunnels at different levels of your spine and go to different parts of your legs.
Between each of these vertebrae are the discs. These are the shock absorbers of the spine. Each disc has two parts—a tough outer wall called the annulus, and a softer center called the nucleus pulposus.
Here’s what happens during a disc herniation. Sometimes a hole can form in that outer wall—the annulus. When this happens, the softer center, the nucleus pulposus, can squeeze through this hole—similar to what we see here. This herniated disc can cause two problems. First, it triggers significant inflammation around the nearby nerve root, causing pain and sometimes tingling sensations down the leg. This inflammation often subsides within six weeks or so, after which the pain can go away.
However, if that herniated disc fragment is large enough, it can actually put physical pressure on the nerve. This pressure may not just cause pain and tingling—it can cause numbness and weakness in your leg. And these symptoms may not go away without further intervention.
When Surgery Is Necessary
When you first experience pain from a herniated disc, oftentimes non-surgical treatments will help alleviate your pain while your body works to minimize the inflammation. Many people with disc herniations are able to successfully treat their pain without needing surgery.
Let’s talk about when surgery becomes necessary. If you have weakness associated with the nerve compression, then surgery is important to unpinch the nerve and prevent worsening weakness. If you have persistent pain despite trying a course of conservative treatment options, then this would be another reason to consider surgery for a herniated disc.
Typically, if you don’t have any weakness, you should try at least six weeks of non-surgical treatments. This can include physical therapy, medications, and steroid injections around the nerve aimed at reducing the inflammation and pain. Oftentimes, a person’s body can heal enough within six weeks that the pain goes away and surgery isn’t necessary. Then over time, your body can reabsorb that herniated soft disc fragment.
Outcomes
The goal of surgery is straightforward—remove the herniated portion of the disc and unpinch the nerve. Now here’s something crucial you need to understand about outcomes. The surgery is extremely effective at treating pain. Many patients notice immediate relief.
However, as I alluded to before, numbness and weakness are more complex. We can’t predict exactly how much numbness and weakness will improve after surgery—nor can we predict how quickly it will improve. This is because the numbness and weakness can be the direct result of nerve damage, as opposed to the nerve being pinched.
Think of it this way: surgery removes the pressure on the nerve, giving it the opportunity to heal. But the nerve has to do the healing itself. This healing process can take up to a full year, and the extent of healing is unpredictable.
Surgical Procedure
Now let me take you through the actual surgical procedure step by step. There are four main stages to a lumbar discectomy.
Stage one is the incision. We make a careful incision in the low back—typically in the middle or slightly to the side. This location is precisely planned based on the location of your specific disc herniation.
Stage two is exposure to the spine. This is where we carefully move the muscles to access the back portion of the vertebrae.
Stage three is the most critical part—and that’s unpinching the nerve and removing the herniated disc. First, we remove a small portion of the bone and ligament to access the disc. Think of this like creating a window to reach the problem area. Once we can see the nerve, we carefully remove any additional bone or ligament that might be pressing on it. Then, we gently gain access to the herniated disc fragment. The nerve is carefully protected during this time, and we remove the herniated fragment, allowing the nerve to relax back into its normal position. This gives the patient relief from their shooting leg pain.
Stage four is closure. We carefully close the surgical site in layers, ensuring proper healing.
Expectations After Surgery
So what can you expect after surgery? Most people do remarkably well. You can typically expect complete or near-complete elimination of your shooting pain down your leg. About 60% of people will also have significant improvement in their low back pain. While surgery can immediately stop any progression of weakness, the actual improvement in weakness and numbness can take time—up to a full year for the nerve to heal.
After this year, you’ll have a better understanding of what weakness may be permanent. This is why proper expectations and patience during recovery are so important.
Risks
This surgery is relatively safe and well tolerated. However, there are risks associated with the procedure—as with any operation.
Common risks include the possibility of a small tear in the protective covering of the nerves, called the dura. If this dura tears, it can lead to leaking of spinal fluid, potentially requiring additional treatment. There’s also a small chance of infection or bleeding around the nerves. Nerve damage can occur, which may result in ongoing pain or numbness in the legs—but this risk is very low.
Additionally, there’s always a possibility that a herniated disc can come back. Remember that hole in the annulus? That hole heals over time, but that soft jelly—the nucleus pulposus—can still shoot through that hole and cause a recurrent disc herniation.
That’s why it’s imperative that after surgery, you closely follow your surgeon’s recommendations. This may include wearing a brace and modifying your activities. The goal is to prevent a recurrent disc herniation later on.
Factors like your age, weight, other medical conditions such as diabetes, and whether you smoke can all affect how you recover from that surgery. Despite these risks, the surgery often helps relieve pain and improve daily functioning for many people.
I’ve performed hundreds of these procedures, and the key to success is precision and attention to detail at every step—from the precise planning of the incision location to the careful handling of the nerve. Every movement matters.
Remember, while any surgery can seem daunting, understanding exactly what happens during the procedure can help ease your concerns and set proper expectations for your recovery.